Reimbursement Methodology AHIMA Exam Questions With 100% Correct Answers

Reimbursement Methodology AHIMA Exam Questions With 100% Correct Answers The financial manager of the physician group practice explained that the healthcare insurance company would be reimbursing the practice for its treatment of the exacerbation of congestive heart failure that Mrs. Zale experienced. The exacerbation, treatment, and resolution covered approximately five weeks. The payment covered *All The Services That Mrs. Zale Incurred During The Period*. What method of reimbursement was the physician group practice receiving? - answerEpisode-of-care The notice from the healthcare insurance plan used the abbreviation "PMPM." How should the insurance analyst interpret this abbreviation? - answerPer member per month The ICD-10-CM/PCS Coordination and Maintenance Committee is composed of representatives from __________ and __________ - answerNCHS and CMS In which type of reimbursement methodology do healthcare insurance companies reimburse providers after the costs have been incurred? - answerRetrospective payment The health plan reimburses Dr. Tan $15 per patient per month. In January, Dr. Tan was contracted with the health plan to serve 300 members, of which he provided services to 100. He received $4,500 from the health plan. What method is the health plan using to reimburse Dr. Tan? - answerCapitated rate In which type of healthcare payment method does the healthcare plan pay for each service that a provider renders? - answerFee-for-service reimbursement All of the following are discounted fee-for-service healthcare payment methods except: CRG CPR 10 RBRVS UCR - answerCRG CPT Category III codes represent: - answerEmerging technologies In which type of reimbursement methodology does the health insurance company have the greatest degree of risk? - answerRetrospective ____was created for reporting procedures and services performed by physicians in clinical practice? - answerCPT The coding system that is used for reporting diagnoses for hospital inpatients is known as __________. - answerICD-10-CM The Health Insurance Portability and Accountability Act (HIPPA) was enacted in __________. - answer1996 _________maintains the International Classification of Diseases (ICD) - answerthe World Health Organization (WHO) HCPCS Level II codes begin with - answeran alpha character followed by four numbers (A1234) The official publication for CPT® coding issues and guidance is called the: - answerCPT Assistant by the AMA In the IPPS, ____________ is the term for each hospital's unique standardized amount based on its costs per Medicare discharge - answer"base payment rate" Patients with all the following conditions are appropriate for LTCHs except _______, ventilator-dependent emphysema sequelae of head trauma Chronic tuberculosis Acute myocardial infarction - answeracute myocardial infarctions The MS-DRG payment includes reimbursement for all of the following inpatient services except _______ Skilled nursing facility Long-term care hospital Inpatient rehabilitation hospital Home health agency - answerSkilled nursing facility SNF _______provides the underpinning of the Home Health PPS - answerOASIS ___is the classification system used to case-mix adjust the SNF per-diem rates. - answerRefined RUG-III